In Our Own Words

An Aging Population -- Why Can't NPs Provide Needed Care?

The Washington Post reported last week that by 2030, the number of adults 65 years and older will make up almost 20% of the population. Currently, this age group makes up 12% of the U.S. population and accounts for:

* 26% of all physician office visits
* 35% of all hospital stays
* 34% of all prescriptions
* 38% of all emergency-medical-service responses
* 90% of all nursing-home use

John Rowe, professor of health policy and management at Columbia University headed an Institute of Medicine panel that released a report on the healthcare outlook for the 78 million baby boomers about to begin turning 65. The report from the arm of the National Academy of Sciences reiterated:

*  There aren't enough specialists. It found there are about 7100 US physicians  certified in geriatrics, one per every 2500 older Americans.
*  Insufficient training is available.
*  Specialists are underpaid.
* Medicare fails to provide for team care that many seniors need.

The report said Medicare may hinder seniors from getting the best care because of its low reimbursement rates, a focus on treating short-term health problems rather than managing chronic conditions, and lack of coverage for preventive services.

Aren’t these aspects of care that nurse practitioners are so well trained in? We may be able to solve the impending looming healthcare crisis.

NPs – what do you think?

English Only?

Over the weekend (after 3 long night shifts in the ICU), there was an incident and controversy about the use of English vs other foreign dialects spoken by employees within the Unit. Imagine that you are on Jeopardy, and Alex Trebek gives the answer:  "This is the official language of the United States."  You buzz in and blurt out, "What is English?" Just like that, you lose the money.

Although English has long held supremacy in our national consciousness, the truth is there is no official language of the United States. So, we may be in for a rude awakening in the form of a civil-rights lawsuit if we have an English-only workplace. Yet, on the other hand…

What should an employer who desires to implement an English-only workplace policy do? First of all, the employer, while recognizing that the workplace is not and cannot be a democracy, should be sensitive to the varying life experiences and perceptions that are brought into the workplace by employees with diverse backgrounds and experiences. Because of this, the employer should take the time to communicate effectively with all employees to ensure that an English-only policy is fully explained to everyone.

All employees may not agree with the business reasons asserted by the employer, but at least they will recognize that the employer believes there is a business reason for the policy, and it is not being imposed simply to discriminate against or offend any group of employees. This seems to be such a sensitive topic….

An English-only policy would be highly controversial in nursing, no matter how it is explained. If it is implemented by simply posting a memorandum on a bulletin board without explanation, the reaction of some nurses is likely to be extremely negative and they may feel personally offended by the policy. Some nurses may well feel they are being discriminated against because they were not born in this country. As immigration patterns have shifted in the United States from Central and Western Europe in the early part of the century to Central and South America today, the emotional issue of language may well be tied to perceptions of national origin discrimination by nurses.

What are your thoughts about an English-only policy in the workplace? Has this been mandated where you work?

Workplace Violence: Disruptive Behavior, Bullying, Verbal Abuse

Over the last couple of weeks there has been a disturbing video shown within the media involving young teenage girls assaulting another teen. Premeditated violence? Their ages range from 14 to 18 years with charges having been filed as adults for each. This leads me to wonder about a new article that I read about workplace gossip within nursing.

Disruptive behavior such as bullying, lateral violence, and verbal abuse is so common in healthcare settings that the Center for American Nurses  recently released a position statement calling for zero tolerance to lateral violence and bullying in nursing work environments. The Joint Commission also proposed new standards that will require organizations to develop codes of conduct that define and address inappropriate workplace behavior.

Whose responsibility is it to stop disruptive behavior? How do we even stop the bullying and gossip that seems to run rampant? Why not use that time to formulate strategies to solve current issues within nursing? Instead, it is all too easy to ignore the behaviors seen within nursing, rather than to confront them? Gossip, backstabbing, withholding of information, and shunning of our co-workers are all forms of workplace violence. Apparently, this trend appears to be growing.

Have you been a victim of workplace violence? If so, please share your story with us.

(For more information on The Center for American Nurses' position statement, visit www.centerforamericannurses.org/positions/lateralviolence.pdf)

Giving to Honduras

My photographer, Michael, who documented my DBS Surgery in 2004 as a pictorial essay (www.parasphotography.com/beka.html), left me a message teling  me that he was headed to Honduras,on a mission once again this  April. In support of the New York Honduran Committee, 11 volunteers travel to Tela, Honduras, one of the poorest countries in the western hemisphere, to provide free health care. The medical team examined more than 220 patients and performed 28 surgical procedures in 2007.

These health professionals performed health evaluations, hearing and speech screenings, and major and minor surgeries for children and adults. In addition, they provided many people with donated hearing devices. The medical mission is always geared first towards children, but each year they see many adults who are in need as well. Michael went along to photograph the journey, the dirt, the isolation, the lack of basic necessities, and other needs. In a country where most people can't afford basic health care, the chance for free surgeries and exams can be a life-saving opportunity.

I have always wanted to go on a medical mission, or even to join the Peace Corps (Maybe I’m too old for that now?) Have any of our readers gone on a medical mission? Tell us about it.

See the Honduras 2007 Essay here.

Some information on joining medical trips:  So You Want to Go on a Medical Mission

A Dreadful Event

I recently attended a fundraiser for movement disorders. It was the worst one ever. During the event I excused myself, and hung out in the gold-plated restroom until I thought the guest speaker was done with her awful, dreadful, unpleasant, and simply terrible speech.

She was a well-known actress who thought we would all be as interested in her life story as she was, including many lurid and explicit details. Her juicy speech seemed to go on forever, making me think the event planners had either not given her a time limit, or that she had ignored it. However, she forgot to mention that there are over 40 million Americans living with a movement disorder today (source: http://www.life-in-motion.org).

The event was for the supporters of a medical school and their expanding movement disorder program. It was all about science, saving lives, research, and how we could help (hint: $$$$). However, I found the disconnect between the speaker and the purpose of the event unbearably painful. I later felt badly for the event planners who had put that one together. But I had heard it all before at other events that I had attended – the galas, dinners, symposiums, “think-tank scientific forums,” “dog walks,”  golf invitational events at exclusive high-end golf  clubs (I certainly was no golfer -- not with my head twisting to the left -- where do you think the ball landed on the greens ?).

At all of these events, there was little focus on actual patients living with movement disorders.
The gist of the event really was that we all wanted to see the celebrity of the evening. Right? Well, I saw her. No doubts about that. But, where was the money for patient care? The movement disorder program? Perhaps forgotten in the focus of the evening.

Maybe we should keep it simpler and keep the emphasis where it should be. How about a fundraiser called “Pizza for a Purpose?!”

Spring Blooms

I don’t like the time re-adjustment that happens in the US in the spring (Daylight Savings Time). Well, that’s not really true: I don’t like the mornings, but I do like the daylight in the evenings. I’m a late riser -- 12 noon usually -- and the time change means I’m getting up earlier, according to my body clock. There isn’t enough Starbucks’ coffee in the world to cope with this sort of thing.

But even as I struggle to adjust, I walk the neighborhoods on the Upper East Side, passing flower shops and bodega cafes. The spring blooms are out on the sidewalks by 10 am. Shipments are delivered well before daylight arrives – around 5 am. Boxes filled with carnations, lilies, tulips, and daffodils- true signs that warmer weather is coming.

Of course, for me -- this could only mean “beach weather” -- time spent on the South Jersey Shore. A few years ago we had had a warm spell in April; I found myself listening to the ocean roar and the waves pounding the white sand, as I munched on a hamburger, sunbathing on the Shore.

I’m ready for spring and the onset of summer. How about you?

New CPR Guidelines Coming?

Imagine – sitting on the bus (no one knows you are a nurse) and someone calls out “Help!”  A person collapses. Everyone stands still as the bus comes to a sudden halt. What do you do? Run off the bus, or say “I can help- I’m a nurse?” Bystanders who see someone suddenly collapse should quickly give the person chest compressions even if they are not trained in cardiopulmonary resuscitation -- the American Heart Association (AHA) released this new recommendation this past week.

The AHA urged people not to stand idly by because they do not think they know how to administer CPR while an adult stricken with acute cardiac arrest is dying in front of them. (People still stand by idly and watch dumbfounded at these events, don’t you think?)

In recommendations published in its journal Circulation, the group emphasized "hands-only" CPR -- a simple procedure that bystanders can perform without worrying about doing the mouth-to-mouth part of CPR. All too often, no one at the scene does anything to help the victim of sudden cardiac arrest -- often because there is no one trained in CPR and the general public is scared that they will do something to make the victim's condition worse.

Will this be a new recommendation added to BCLS?  Have you tried to save a life outside of the medical setting? If so, do share your amazing story with us.

Change of Shift - Enterprise Edition

Don't miss the newest edition of Change of Shift -- seen through the eyes of the Enterprise's Nurse Chapel!